Healthcare Provider Details

I. General information

NPI: 1598233835
Provider Name (Legal Business Name): JAMES SPRINGFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 11/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 HOWELL MILL RD NW APT 1506
ATLANTA GA
30318-5689
US

IV. Provider business mailing address

930 HOWELL MILL RD NW APT 1506
ATLANTA GA
30318-5689
US

V. Phone/Fax

Practice location:
  • Phone: 404-849-0265
  • Fax:
Mailing address:
  • Phone: 404-849-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: